CA1091558A

CA1091558A - Blood control standard

Info

Publication number: CA1091558A
Application number: CA307,901A
Authority: CA
Inventors: Allan L. Louderback
Original assignee: Individual
Current assignee: Individual
Priority date: 1977-11-22
Filing date: 1978-07-21
Publication date: 1980-12-16
Also published as: DK385778A; IT7851983A0; DK155029C; CH639492A5; IT1157714B; DE2850627A1; US4126575A; BE872187A; GB2008245A; FR2408838B1; FR2408838A1; JPS5757662B2; GB2008245B; JPS5479991A; DK155029B; DE2850627C2

Abstract

IMPROVED BLOOD CONTROL STANDARD

ABSTRACT

A stable blood control standard and method is provided for the quality control of the measurement of blood pH and gases in the clinical laboratory. The blood control standard comprises a sealed receptacle containing specially treated red cells and a gaseous head space at least equal to about the volume of the red cells. The special treatment comprises thorough washing and separating the red cells from the plasma components and mild treatment with aldehyde and retention in a buffered solution.
The special treatment also includes treating at least a portion of the red cells with carbon monoxide. The head space comprises from 0-15% CO2, 0-25% O2 and the balance N2 and/or inert gas.

Description

~ SS~ j ~ BACKGROUND OF THE INVENTION
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¦ This invention relates to a blood control standard. More particularly, this invention is concerned with a stable blood control standard and method for the quality control of the measure-~ment of blood pH and gases in the clinical laboratory.
Blood serum is a complex biological fluid containing various components of substantial physiological importance. In the normal or average healthy person the concentrations of these components fall within certain reasonably well~defined limits. When any of these components is found upon analysis to be outside of its norma L
range, a pathological condition may be indicated which requires ;medical attention.
¦ The determination of blood gases, electrolytes and the acid-base balance is an important aspect of this blood analysis. Thus, ¦abnormalities in pulmonary function may be indicated by the concen-¦trations of oxygen and carbon dioxide in the blood. The importance ¦of oxygen transport by the blood in respiration and the respiratory regulation of cation-anion balance is well known. By the process o E
homeostasis, the body tends to preserve a state of equilibrium ¦which is manifested in three ways as applied to water and electro-lyte metabolism:
1. Preservation of pH or acid-base balance.

2. Preservation of ionic composition.

3. Preservation of osmolality.
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¦ The buffer systems of the intra-and extra-cellular spaces 't' ¦Ipreserve the pH within narrow limits~ Of the various physiological buffers, only the bicarbonate system contains a component, carbon dioxide, which is volatile at body temperatures and, therefore, can be regulated by the lungs. ~hus, an analysis of the bicarbonate buffer system enables a direct estimation of the respiratory acid-base balance. Dissolved carbon dioxide is present in plasma ;' `-' . ~
~ ~2-10915~8 ¦according to the following equation:

2 H20 -H2C03 = H + HC03-Carbon dioxide also is present in the red cells in the dissolved state, or combined with hemog:Lobin to form carbamino-C02, or in a complex based on the action of the enzyme, earbonie anhydrase, which is present in the erythroeytes.
The interrelation between total C02, bicarbonate, carbonic acid, PC02 and pH in blood can be shown by the well-known Henderso _ Hasselbalch equation:

~ pH = pK + log 3 .',. ` I (H2C03 ) '''`
in which pH is the pH measured in arterial blood pK is the log of the reciprocal of the dissociation constant of the bicarbonate system ¦;HCO3 is the true biearbonate concentration in mmol/liter.
H2C03 is the carbonic acid eoncentration in mmol/liter The values for pH, total C02 and PC02 ean be determined experi-mentally and their mathematieal relationships ean then be illustra ted by applieation of the Henderson-Hasselbaleh equation.
Various instruments have been developed for the determination f the parameters whieh eomprise the blood gases and aeid-base balanee. These instruments generally are capable of measuring bloc P~ PCo2 and Po2- Illustrative of such instruments are those described in U.S. Pat. Nos. 3,658,478 and 3,652,843. Instruments of t},is type are commercially available from Instrumentation Laboratory Ine. as the IL 113 pH/Blood Gas Analyzer. Another sueh instrument is the Corning pH/Blood Gas Analyzer deseribed in U.S.
Pat. No. 3,763,422. Still another commercially available instru-ment for measuring blood pH, P02 and PC02 is the BMS3 Mk2 Blood Micro System and Digital Acid-Base Analyzer from The London Company , _~_ i~ r~8 Radiometer A/S Instruments of the latter type are described in ~U.S. Pat Nos~ 3,654,445 and 3,874,850.
I The use of the foregoing and other such instruments for the ¦determination of blood gases in the clinical laboratory presents ~unique problems of quality control. The instruments must, of course, be properly calibrated in the first instance. Calibration ~of such instruments can be accomplished by mete~ing st2ndardized gases through the instrument or by application of a caliberation fluid such as an aqueous bicarbonate solution as described, for example, in U.S. Pat~ No. 3,681,255. However, calibration of the instrument is only one of the problems of blood gas clinical instrumentation. To ensure high quality patient care, the instru-mentation system must be tested frequently and laboratory personnel must be promptly responsive to any system malfunction. For the later purpose, control standards have been developed which can be applied to the instrument periodically at predetermined intervals ~`~ to ensure adequate quality control. One such type of control standard is a freeze dried human serum which is reconstituted with a liquid diluent prior to use. Examples of this type of ¦control standard are described in U.S. Pat.No.s. 3,466,249 and 3,629,412. These materials, however, are not fully useful for control purposes when the blood gas analysis includes determination of oxygen because the reconstituted serum does not contain the desired level of dissolved oxygen. Rather, they are adapted to control other biological values such as are determined on a Technicon SMA/12 Auto Analyzer.
Another such control standard contains blood which is reconstituted by the addition of a liquid containing fluoride and an iodoacetate or a fluoroacetate to stabilize the blood as disclosed in U.S. Pat. No. 3,859,049. However~ this material similarily does not provide the desired levels of oxygen for the control of instruments which include the determination of blood oxygen.

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Although it i5 known that blood cells can be stabilized by various chemical fixatives as described in U.S. Pat. Nos.
3,574,137 and 3,640,896 or by thoroughly washing to separate from other blood constituents a!~ described in U.S. Pat. No.
3,558,522, these materials are useful only for blood counting and similar such ~urposes and do not provide the necessary conditions for the control o~ blood pH and gases.
It is also known that blood cells can be stabilized for hemaglutination purposes or to serYe as ~f~inity absor-bents for antigens or antibodies by rigorous treatment of the cells with aldehydes. Such treatment for use in diagnostic tests is described in U.S. ~at. Nos. 3,096,250, 3,426,123, 3,708,572, 3,714,345, 3,925,541 and U.S~ Pat. No. 3,914,400.
Again, these materials are useful ~or the disclosed diagnostic purposes but do not proYide the herein-described conditions for .
control of blood pH and gases.
s A recent patent haa issued to Allan Louderback, namely, U.S~ ~at~ No. 3,973~913 the same in~entor as herein. The patentee has disclosed a stable blood control standard and ~`
method for the quality control of the measurement of blood ~H
and gases in the clinical laboratory. ~hile the technique in-` cludes a sealed receptacle containing specially treated red cells and a gaseous head space at least equal to about the ~ol-ume of the red cells. Howeyer, no consideration in this prior - art has been given to way to obtain Yariable carbon monoxide ... , : .
- leyels ~ith a whole bl~od product.
If one would just incorporate a quantity of carbon monoxide in the space aboYe the blood in a glass vial, for in-stance, the results would be variable depending on how long one gassed the vials with carbon monoxide and then followed by gas-sing with variable oxygen, carbon dioxide and nitrogen in dif~
ferent concentrations as described in the above mentioned patent. , , . .

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cm:

.','' :, ~ : ' ,. ' , ' ' , , S5~ 1 BRIEF SUMMARY OF THE INVENTION

In accordance with the present invention, a stable blood control standard and method is provided for the quality control of the measurement of blood pH and gases in the clinial labora-tory. The blood control stanclard comprises a sealed receptacle containing specially treated red cells and a gaseous head space of at least equal to about the volume of the treated blood cells.
This special treatment comprises thorough washing and separating of the red cells from the plasma componenets and mild treatment with aldehyde and retention in a buffered solution. This is accomplished by making red cells 100% saturated with carbon monoxide by long exposure in a stirring solution. Then about five parts of the 100% saturated cells are mixed with 95 parts of normal or subnormal cells to obtain a concentration of cells with about ~ carbon monoxide~ The head space consists of a gas or mixture of gases comprising from 0 to 15% CO2, 0 to 25% 2 and the balance substantially N2 and/or inert gas.
The resultant in a whole blood control designed to verify the analyses of an oximeter instrument which is designed to provide information on one or more of the following assayed constituents:
Consti~tuents Also Known As ~eported As Total Hemoglobin Hemoglobin (g~dl T Ab) Percent Oxyhemoglobin 2 Saturation (~ 2 Hb) Percent Carboxyhemoglobin CO Saturation (% COHb) Oxygen Content 2 Content (Vol % 2) Definitive Clinical Importance of the Measurement of Above Constituents ~..
Hemoglobin - The role of hemoglobin is well documented and is traditiona71y a measurement of utmost importance in clinical medicine. In the clinical blood gas application, hemoglobin is responsible for carrying gases as oxygen, carbon dioxide and carbon monoxide.

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Oxyhemoglobin - A ratio of the amount of hemoglobin combined with oxygen in relation to amount of hemoglobin available for oxygenation.

Carbon Monoxide -Carbon monoxide is not normally present 85 a metabolic end product in human blood. Environ-mental exposure can increase the level appre-ciably. Carbon monoxide is present in smoke and automotive exhaust. City dwellers who are non-smokers have carboxyhemoglobin levels of less than three percent. In heavy smokers, asmuc~
as ten percent or more of blood hemoglobin may be combined with carbon monoxide.
Carboxyhemoglobin is not an active carrier of blood oxygen. Its poisoning effect of preventing of oxygen binding with hemoglobin is recognized as being much more serious than the loss of a similar amount of hemoglobin by anemia.

Methemoqlobin - Metemoglobin is an "inactive" hemoglobin it is unable to combine reversibly with oxygen and carbon monoxide. It hinders the transfer of oxygen from blood to the tissues with cynanosis occurring at levels of 10 - 20~ Met Hb.

Oxyqen Content - The total amount of oxygen in the blood; a summation of oxyhemoglobin and dissolved oxygen.

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DETAI~ED DESCRIPTION OF THE INVENTION

¦ The principal fractions of blood are the plasma, red ¦¦cells or erythrocytes, platelets and white cells. In the average l ~adult human b dy which contains about 5 1iters of blood,the red cel~

_7_ represent about 2.2 liters. In accordance with the present inven-tion, ~hese red cells are first separated from the other blood components and then treated as defined herein.
In order to prevent clotting in storage, whole blood is nor-mally collected in an anticoagulant solution such as heparin, EDTA
ACD or CPD solution. Whole blood collected in this manner can -~ normally be stored for up to 21 to 28 days without seriously ¦affecting the viability of the residual red cells. Since the end of World War II, the collection and storage of blood has undergone considerable change, and various advances in the separation of the blood components have qiven rise to the practice o~ modern blood component therapy. By these procedures, the red cells can be separated from whole blood by sedimentation and centriugation. The separated red cells can be glycerolized and then stored in a frozen state for subsequent use. Similarly, ~ Ithe separated plasma can also be frozen and stored, or its separat~
- Iplasma can also be frozen and stored, or its separated fractions can be frozen and stored for latter use.
In accordance with the present invention, any of the above sources of red cells, fresh or outdated cells (cells stored in excess of 21 to 28 days~ can be employed. These cells can be derived from human or other mammalian sources including, for ¦example, equine, bovine, porcine, and sheep species.
In order to ensure complete separation from the other blood ¦components the red cells are sedimented or centrifuged and thoroughly washed. Sedimentation is facilitated by spinning in a conventional blood centrifuge. Centrifuges for such blood cell sedimentation axe well-known, and a continuous flow type centrifug~
such as in com~ercially available from the Haemonetics Corp.
is preferred. Centrifuges, of this type are described, for exampl~ , in U.S. Pat. No. ~,706,412. In this type of cen~rifuge, the bowl ; ¦has two parts, one that rotates and another that is stationary.
` ¦~s the blood or previously separated red cells enter the spinning bowl, the cells are distributed to the periphery and as the ~1 1091558 Ibowl fills, the supernatant separates from the red cells. The ¦red cells are held in suspension by centrifugal force while the supernatanat is expelled through an effluent port into a waste ¦collection receptacle.
¦ I A washing solution is then made to follow the same path as the red cells. The washing solution is a saline solution which preferably is normal physiological saline containing about 0.9%
NaCl but can also contain other substances such as, for example, the componenets of Alsever's solution. The geometry of the centri fuge keeps the cells circulating against the flow of fresh wash solution as the used wash solution is expelled through the effluen port. When the washing is complete, the centrifuge is stopped and the washed cells are siphoned into a separate collection vessel.
Another example of a conventional blood centrifuge that is suitable for use in the invention is the Celltrifuge separator which is commercially available from the American Instrument Company.
In the foregoing washing procedures, the red cells are preferably washed with from about 5 to about 30 volumes of the saline washing solution. In a preferred example, a unit of blood (one point) is washed with about 3-4 liters of saline.
Following the saline washing, the red cells are ready for the mild treatment with aldehyde. If not treated immediately, it is preferred to temporarily store the cells in Alsever's solution~ This solution can be prepared by admixing the following components in the stated amounts and diluting with water to a volume of three liters.
.'' Components Amount Glucose (dextrose) 61.5 grams Sodium Citrate 24.0 grams Sodium Chloride 12.6 grams Citric acid (1% solution) 15.6 ml.
Neomycin 300 mg Chloramphenicol 990 mg _g_ I1 ~05~SS~ ~
l ~
The components should be mixed well and the pH adjusted to ~ithin a range of about 6.4 to 6.8. The washed red cells can be retained in the Alsever's solution for about 45 days at 2 to 8 C.
The washed red cells, when ready for the aldehyde treatment, are first re-suspended in saline solution in proportions of about one part by volume of cells to about 50 to 30 parts by volume of th saline. The mild treatment with aldehyde which follows comprises the relatively slow addition of a saline solution of the aldehyde to the cells and admixing at room temperature and generally within ¦the range of about 20 to about 26 C~ The aldehyde solution preferably ranges from about 0.1 to about 0.6 molar aldehyde in saline. Aldehyde substances which are employed in the aldehyde/
saline solution generally are aliphatic aldehydes having from one to about six carbon atoms, such as, for example formaldehyde, acetaldehyde, propionaldehyde, butyraldehyde, malonic aldehyde, I
succinaldehyde, glutaraldenyde, and pyruvic aldehydeO The saline preferably is normal physiological saline and the aldehyde ~referably is a monoaldehyde, especially formaldehydeO The uspension of the red cells in the aldehyde/saline solution is ~ixed such as by stirring for about 15 minutes to about 4 hours, preferably about 60 minutes, during which time the cells take on a bright red appearance which resembles fresh arterial blood. ¦
~ ollowing the mild treatment with aldehyde, the treated cells ¦
are sedimented such as by centrifugation and again washed with saline in about the same range of proportions as in the initial saline washing. As before, the red cells can be used directly in the next step or the cells can be temporarily stored in Alsever's solution at 2~ to 8 C.
Thereafter, a portion of the red cells in a saline solution are completely saturated with carbon monoxide for a period of 15 ~o 30 minutes with continuous stirring. After saturation 5 parts Df the carbon monoxide saturated red cells are combined with 95 ,, -10-I
I

1~ 1(191~58 parts of the portion, i.e., untreated with carbon monoxide to produce a 5% carbon monoxide red cell combinati~n. Likewise other concentrations are prepared, i.e., 10 parts of the carbon monoxide saturated red cells with 90 parts of the other unsaturated portion. ~lso, any number of parts of the carbon monoxide saturated red cell with (100-any) parts of the unsaturate portion.
After completion of the treatment, the red cells are buffered and transferred into suitable receptacles which are capable of being sealed so as to be completely gas tight from the ambient akmosphere. These receptacles can be, for example, glass ampules, vials or bottles.
The buffering of the cells,while not necessary, is such as to maintain a desired pH of from about 6.0 to about 7.7, depending upon whether the blood control standard is to be representative of the normal range, acidosis or alkalosis. Under normal circumstances the normal range is about 7.4*0.1 while the acidosis is 7.0-7.3 and alkalosis is 7.6+0.1. The molarity of the buffer preferably is from about 0.05 to about 0.2 molar.
Conventional buffer materials such as, for example, phosphate and tris buffers can be used, but phosphate is generally useful only at pH about 7.5. Preferred buffer materials for maintaining the desired pH are N-tris(hydroxymethyl) methyl-2-aminoethanesul-fonic acid (TES) and N-2-hydroxyethylpiperazine-N1-2-ethane-sulfonic acicl (HEPES). These and other such suitable buffer materials are described by Good et al.,Biochemistry, 5, 467-77 (1966).
Sufficient bicarbonate ion, for example, NaHCO3, also is added to the red cells to bring the PCO2 to a level of from about 20 to about 55 mm Hg.
The buffered cells are placed into the receptacles to a level such as to leave a head space at least equal to about the volume of red cells. This head space is then filled with a gas or a mixture of qases compri~ing 0-15% CO2, 0-25~02 and the t~t~
balance N2 an~ r inert gas. As used hel n, the term inert yas refers to any g~s which is inert to the reactions which take place in the electrode sy~tems of the blood pH and gas analyzer instru-ments. This includes the so-called inert gases which have a com-pleted group of electrons in their outermost shells, for example, He, Ne, Ar, Kr, Xe and Rn. These gases can be added from separate gas sources or as a preadmixture of the desired gases.
The elctrodes referred to above are the conventional pH, PCO2 and PO2 electrodes used in the blood pH and gas analysis instruments described hereinbefore. For example, the hydrogen ion concentration may be monitored with a pH responsive glass electrode, in cooperation with a Ag/AgCl reference electrode, the partial pressure of carbon dioxide may be sensed in the circulatin~
fluid by a CO2 electrode and the oxygen may be monitored with an - ¦oxygen-sensing electrode.
In order to ensure that the blood control standard will be saturated with the desired gas, the gas prefereably is flushed into the receptacle in a volume of from about 10 to about 60 times the volume of the receptacle and the receptacle is then immediatel~ , sealed before any significant exchange with atmospheric gas can take place. The desired gas tight sealing can be achieved, for example, by using a glass ampule as the receptacle and melting the top of the ampule in a flame to provide a flame-sealed closure. In the case of vials or bottles, other types of conven-tional hermetic sealing can be employed.
The gases in the sealed receptacle will then come into equilibrium with the red cells to provide, in essence, a miniature tonometer. This final product remains stable and pro-vides the desired pH, PO2 and PCO2 values for extended periods, for example~ up to six months, when stored at about 2 to 8 C.
The presence of the red cells also supplies hemoglobin to the blooc controI standard and, thereby, enables the determination of Base Excess, from which one can calcula~e 2 content and 2 saturation.
Of course, it is contemplated within the purview of the invention that the calls may be sealed by themselves to be ~ust a control for carbon monoxide and oxygen s~turation, which varies s~

i.e., decreas s in pr~porti~n ~o the level that the carbon m~n-oxide increases.
The following detailed example will further illustrate the ¦invention ~lthough it will be appreciated thatthe invention is not limited to this specific example.
~XAMPLE
A unit ~one pint) a fresh human blood collected in ACD
or CPD anticoagulant solution is expressed into a Haemonetics Corp. continuous flow centrifuge. As the blood enters the centrifuge, the red cells are distributed to the periphery and the supernatant is expelled through the effluent port. While spinning, the cells are washed with 3 to 4 liters of a washing solution comprising an aqueous solution of 0.9% NaCl (normal physiological saline). The washed red cells are siphoned into a collection vessel and then transferred to a vessel containing five liters of normal physiological saline. The red cells/saline mixture at 25C. is then added slowly over a brief time period of 5 to 10 minutes 500ml of saline containing 40 ml of formaldehyde (37%) solution to thereby provide a 0.1 molar formaldehyde in 0.9 Na~l solution. The mixture is stirred at 25~C. for 60 minutes, during which time the cells assume a bright red color resembling fresh arterial blood. The formaldehyde treated cell mixture is then trans~erred to the continuous flow centrifuge wherein the cells are further washed with 6 to 8 liters of 0.9% saline solution. The washed cells are then siphoned off into a collectio~
vessel and buffered with an queous solution of 0.1 molar HEPES.
A portion of the resultant is then completely saturated with carbon dioxide for a period of 15 to 30 minutes with continuous stirring. Five parts of which saturated material are combined with 95 parts of the unsaturated portion. Also, in a similar manner 10 parts of such saturated material are combined with,90 parts of the saturated parts. Also, any number ofparts of the ~on monoxiae portion is mixed with (100-any) parts of the concentrated portion to give 5%, 10~ and/or any carbon monoxide levels, respectively.

1 ~139~SS~ I
Il Sufficient NaHCO3 solution is then added to adjust the PCO2 to 40mm Hg. The pH is given a final adjustment to 7.4. The buffered red cells are then tr ~ ferred in two ml~ aliquots into glass ampules (Wheaton No. 1 glass), each having a capacity of 8 ml. A premixed gas containing 5% CO2, 12% 2 and 83~ N2 is then flushed into the ampules at the rate of 600 ml. per 60 second s, each amplule being flushed with 150ml. of gas. The ampules are ir~ediately sealed by rotating the top in a flame and pulling off the tip.
The improved blood cell control of the present invention is needed for an Instruments Laboratory Co~o;:imeter system, i.e., for any instrument measuring carbon monoxide-hemoglobin. What has been disclosed in the foregoing is a way to obtain variable carbon monoxide levels with a whole blood product. If one just put some carbon monoxide in the space above the blood in a glass vial in aCcordance with the teachings in U.S. Pat. No. 3,973,9i3, the results would be variable depending on low long one gassed the vials with variable oxygen, carbon dioxide and nitrogen in diff-erent concentrations as described in the aforementioned patent.
Furthermore, it will be appreciated that carbon monoxide is flammable and cannot be put into a space above the red cells and heat.sealed without causing a small burst of flame.
These red cells at any desired concentration of carbon monoxide can be sealed in glass vials or described in U.S. Pat.
NO. 3,973,913 to obtain a product with variable carbon monoxide, variable oxygen, variable pH and variable carbon dioxide, all independent of each other. Additionally, the blood cells can be increased or decreased to obtain different levels of hemoglobin as described in the aforementioned patent.
Prior to actual use, the resultant improved control standard which had been maintained at 2C to 8C, is treated to eliminate extraneous errors of ambient room ~erature and sample handling by incuhating at 37C for 30 minutes in a water bath to (a) physiologically prepare the sample to that of body temperature, tb) to fully equilibrate t~e sample with the sealed )9~LX5~

gasses and (c) to prepare the sample to resemble a freshlywithdrawn arterial specimen.
Since the measurement of blood gases followed the principles of the natural gas laws temperature is somewhat critical if the sample is to be fully equilibrated to obtain the correct partial pressures. Upon completion of incubation, the ampule is broken and the control sample can be directly aspirated or drawn into a syringe for direct presentation to a blood gas analyzer and/or oximeter lnstrument.

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Claims

What is claimed is:

1. A blood control standard for the quality control of the measurement of blood pH and gases comprising a sealed receptacle containing treated erythrocytes and a gaseous head space having a volume which is at least equal to about the volume of said erythrocytes, said erythrocytes being treated by thorough washing in saline solution, mild admixing with a solution of aldehyde and saline, thorough washing in saline solution, to form a suspension treating at least a portion of the suspension of erythrocytes with carbon monoxide, then combining that portion with a portion of erythrocytes that have been untreated with carbon monoxide,said gaseous head space comprising from about 0% to 15% CO2, from about 0% to about 25%O2, and the balance selected from the group consisting of N2 and inert gases and mixtures thereof.

2. The blood standard of claim 1 wherein the portion of the suspension of erythrocytes treated with carbon monoxide is treated until the erythrocytes are substantially saturated with the carbon monoxide and the relative portions of untreated and treated portions are selected whereby the resultant includes 0% to 100% carbon monoxide treated erythrocytes.

3. The blood control standard of claim 2 in which the aldehyde is an aliphatic aldehyde having from 1 to about 6 carbon atoms.

4. The blood control standard of claim 2 in which the aldehyde is formaldehyde.

5. The blood control standard of claim 2 in which the saline solution is normal physiological saline.

6. The blood control standard of claim 2 in which the aldehyde concentration is from about 0.4 to 0.6 molar.

7. The blood control standard of claim 2 in which the mild admixing with aldehyde is at about 20° to about 26° C, for about 15 minutes to about 4 hours.

8. The blood control standard of claim 2 in which the buffer is selected from the group consisting of HEPES and TES buffers.

9. A blood control standard for the quality control of the measurement of blood pH and gases comprising a sealed receptacle containing treated erythrocytes and a gaseous head space having a volume which is at least equal to about the volume of said ery-throcytes, said erythrocytes being treated by thorough washing in saline solution, mild admixing with a solution of aldehyde and saline, thorough washing in saline solution, buffering to a pH of from about 7 to 7.7 to form a suspension combining with a portion of the suspension of erythrocytes with carbon monoxide, then combining that portion with a portion of erythrocytes that have been untreated with carbon monoxide and admixing with bicarbonate ion to a pCO2 Of from about 20 to about 55 mm Hg, said gaseous head space comprising from about 0% to about 15% CO2, from about 0% to about 25% O2 and the balance selected from the group consisting of N2 and inert gases and mixtures thereof.

10. The blood standard of claim 9 wherein the portion of the suspension of erythrocytes treated with carbon monoxide is treated until the erythrocytes are completely saturated with the carbon monoxide and the relative portions of untreated and treated portions are selected whereby the resultant includes 0% to 100%
carbon monoxide treated erythrocytes.

11. The blood control standard of claim 10 in which the aldehyde is an aliphatic aldehyde having from 1 to about 6 carbon atoms.

12. The blood control standard of claim 9 in which the aldehyde is formaldehyde.

13. The blood control standard of claim 9 in which the saline solution is normal physiological saline.

14. The blood control standard of claim 9 in which the aldehyde concentration is from about 0.4 to about 0.6 molar.

15. The blood control standard of claim 9 in which the mild admixing with aldehyde is at about 20° to about 26° C, for about 15 minutes to about 4 hours.

16. The blood control standard of claim 9 in which the buffer is selected from the group consisting of HEPES and TES buffers.

17. The blood control standard of claim 16 in which the buffer is about 0.05 to about 0.2 molar.

18. The method of making a blood control standard for the quality control of the measurement of blood pH and gases comprising thoroughly washing erythrocytes in saline solution, mildly admixing with a solution of aldehyde and saline, thoroughly washing is saline solution to form a suspension, treating at least a portion of the suspension of erythrocytes with carbon monoxide, then combining that portion with a portion of erythro-cytes that have been untreated with carbon monoxide, transferring to receptacles while leaving a gaseous head space of at least about equal to volume of said erythrocytes, flushing said head space with a gas comprising from about 0% to about 15% CO2 from about 0% to about 25% O2 and the balance selected from the group consisting of N2 and inert gases and mixtures thereof, and immediately thereafter sealing said receptacles to form a gas tight closure.

19. The method of making a blood control standard for the quality control of the measurement of blood pH and gases comprising thoroughly washing erythrocytes in saline solution, mildly admixing with a solution of aldehyde and saline, thoroughly washing in saline solution, buffering to a pH of from about 7 to 7.7 to form a suspension, treating at least a portion of the suspension of erythrocytes with carbon monoxide, then combining that portion with a portion of erythrocytes that have been untreated with carbon monoxide admixing with bicarbonate ion to a pCO2 of from about 20 to about 55 mm Hg, transferring to a receptacle while leaving a gaseous head space of at least about equal to the volume of said crythrocytes, flushing said head space with a gas comprising from about 0% to about 15% CO2, from about 0% to about 25% O2 and the balance selected from the group consisting of N2 and inert gases and mixtures thereof, and immediately thereafter sealing said receptacles to form a gas tight closure.